Authors of section

Author

Cassio Ferrigno

Executive Editor

Amy Kapatkin

General Editor

Noel Moens

Open all credits

Complications with tibial shaft fractures

1. General considerations

The most common complications in tibial shaft fracture are:

  • Nonunion
  • Osteomyelitis
  • Malalignment with malunion

2. Nonunion

Nonunion is the result of a combination of biological and/or mechanical errors that interfere with the bone healing process. In the tibial shaft, there are only muscles in the lateral side. Therefore, the vascular supply of the medial tibia is poor. This can sometimes lead to nonunion. Improper handling of the muscles and soft tissue in combination with poor surgical technique and suboptimal implant selection can lead to tibial nonunion.

complications with tibial shaft fractures

3. Osteomyelitis

Osteomyelitis can occur in the tibia in presence of an open fracture or iatrogenic contamination.

complications with tibial shaft fractures

4. Malalignment with malunion

Rotational malalignment in comminuted fractures can occur due to a lack of recognizable landmarks that aid the surgeon in proper alignment of the limb. Mild loss of length or a moderate malalignment on the sagittal plane (procurvatum or recurvatum) does not affect the patient’s functional outcome, whereas malalignment on the frontal (varus or valgus) or axial plane can severely compromise limb function.

Limb alignment can be assessed by clinical evaluation and intraoperative fluoroscopy or radiographs.

5. Pin too long

The radiograph shows a pin inserted too far caudal into the stifle joint (left) / tarsal joint (right).

complications with tibial shaft fractures

6. Plate too short

Lateral radiograph of a 42-B3 tibial fracture stabilized with a short 3.5mm “string of pearl” plate. Note the sagittal plane angulation.

complications with tibial shaft fractures

Early post-operative failure of the repair by tibial fracture. The failure is likely the result of a combination of a short plate and the weakening effect of the most proximal screw placed through or near the caudal cortex.

complications with tibial shaft fractures

7. Plate failure

When a plate is too short it can lose the biomechanical advantage of bridging the bone, and may lead to a catastrophic implant failure.

Preoperative radiographs of a 42-B2 fracture of the tibia in a 14-year-old Border Terrier.

complications with tibial shaft fractures

The fracture was repaired using a 2.0/2.7 Veterinary Cuttable Plate. Although the plate was intended to work as a neutralization plate, the lack of reduction and stabilization of the short oblique fracture (arrow) make this plate a bridging plate.

complications with tibial shaft fractures

Implant failure by fatigue at 3 weeks postoperative at the level of the previously highlighted short oblique fracture.

complications with tibial shaft fractures

8. External fixator complications

2-year-old American Shorthair cat, fell from a 3-4 floor balcony.

Radiographs of the left leg show a 42-C2 fracture.

definition

Radiographs of the right leg show a 42-C3 fracture.

definition

Post-operative radiographs show fracture was repaired with ESF IA on the left side. The decision was to approach this minimally invasively, although bone plating C2 fractures are recommended.

complications with tibial shaft fractures

The right side was also treated minimally invasively. Note the multiple fissures that made it impossible to place implants in the midsection.

complications with tibial shaft fractures

10 days post-operative radiographs show failure on both the left…

complications with tibial shaft fractures

…and the right side.

complications with tibial shaft fractures

At 10 days after the first surgery the cat was reoperated with 2.4 LCP MIPO on the left side. Although the external fixator type IA may have worked if this was a unilateral injury, bone plating should have been chosen initially in this patient.

complications with tibial shaft fractures

The right side was also treated with 2.4 mm LCP minimally invasively.

complications with tibial shaft fractures

The cat was followed-up radiographically at 2, 3 and 5-months post-operative.

Radiographs at the 5-month follow-up on left show a nonunion.

complications with tibial shaft fractures

Radiographs at the 5-month follow-up on right side show a nonunion.

complications with tibial shaft fractures

Radiographs 2 months after BMP show the left side healing.

complications with tibial shaft fractures

Radiographs 2 months after BMP show the right side healing.

complications with tibial shaft fractures